(provided by the applicant): North Carolina Community Care Networks, Inc., proposes to link three separate databases maintained by the NC Department of Health and Human Resources to create an infrastructure for comparative effectiveness research with medically indigent and uninsured patients who present with complex medical and psychiatric comorbidities. The three databases include statewide Medicaid claims, state psychiatric hospital admissions (HEARTS), and state-funded outpatient mental health services (IPRS). To demonstrate the capabilities of the integrated database, we will conduct a study of medical homes in the NC Medicaid program for patients with complex medical-psychiatric problems. Several hypotheses will be tested to assess the extent to which these patients engage in medical homes as readily as their non-mentally ill counterparts, use their medical homes as mental health homes, and receive high quality care for their mental illness and for medical comorbidities. The project includes the creation of an oversight structure for managing the integrated database and making it available to the research community in NC and elsewhere. PUBLIC HEALTH RELEVANCE: This proposal responds to an urgent national need for a sustainable data infrastructure to enable the study of treatment and policy effects on the health and healthcare of persons with complex medical and mental health co-morbidities. This project will explore the use of the primary care medical home and outcomes for this vulnerable population;and enable access to an ongoing comprehensive database for future research.